Discharge against Medical Advice in Eight Tertiary Hospitals in Nigeria: A Prospective Study.

BACKGROUND: Discharge against medical advice (DAMA) is when a patient decides to leave the hospital without the consent of the treating physician. It poses serious clinical, ethical, and legal challenges to the individual physician as well as the hospital. AIM: To determine the prevalence and reasons for DAMA in orthopedic departments of eight tertiary hospitals in Nigeria. MATERIALS AND METHODS: This was a prospective multi-center descriptive study undertaken in eight tertiary Nigerian hospitals. Consecutive patients who requested for DAMA within 1 year of the study and who consented to participate in the study had face-to-face interviews. Data obtained were documented in a questionnaire and analyzed with SPSS version 20. RESULTS: The total number of patients studied was 373 with a mean age 34.7 ± 17.5 years. About a quarter of them (25.5%) were between 31 and 40 years. A prevalence rate of 1.9% was found with financial constraint being the predominant reason for DAMA (40.8%). Other reasons include family preference for unorthodox treatment (18.8%) and treatment dissatisfaction (7.0%) among others. CONCLUSION: The study findings indicate a low DAMA rate when compared to previous studies in this region. It also indicates that financial constraints, family preference for unorthodox care, and low educational status are major drivers of DAMA. Deepened health insurance and other measures that can reduce the prevalence of DAMA should be prioritized to improve treatment outcomes.

Pregnancy rates and outcomes in women with cystic fibrosis in the UK: comparisons with the general population before and after the introduction of disease-modifying treatment, 2003-17.

OBJECTIVE: To compare pregnancy rates and outcomes for women with cystic fibrosis in the UK with those of the general population and assess the effect of the introduction of disease-modifying treatment. DESIGN: A population-based longitudinal study, 2003-17. SETTING: United Kingdom. POPULATION: Women aged 15-44 years in the UK cystic fibrosis (CF) Registry compared with women in England and Wales. METHODS: We calculated pregnancy and live-birth rates for the CF population and the general population of England and Wales. For women with CF we compared pregnancy rates before and after ivacaftor was introduced in 2013. We further used CF registry data to assess pregnancy outcomes for mothers with CF, and to assess the relationship between maternal pre-pregnancy lung function and nutritional status and child gestational age. MAIN OUTCOME MEASURES: Pregnancy and live-birth rates and child gestational age. RESULTS: Of 3831 women with CF, 661 reported 818 pregnancies. Compared with the general population, the pregnancy rate was 3.3 times lower in the CF population (23.5 versus 77.7 per 1000 woman-years); the live-birth rate was 3.5 times lower (17.4 versus 61.4 per 1000 woman-years) with 70% of pregnancies in CF women resulting in live births; termination of pregnancy rates were also lower (9% versus 22%). Pregnancy rates increased post-ivacaftor for eligible women with CF, from 29.7 to 45.7 per 1000 woman-years. There was no association between pre-pregnancy lung function/nutrition status and gestational age. CONCLUSIONS: Pregnancy rates in women with CF are about one-third of the rates in the general population with favourable outcomes, and increased for eligible women post-ivacaftor. TWEETABLE ABSTRACT: Pregnancy rates in women with CF are about a third of the rate in England and Wales with 70% live births. Ivacaftor increases the rate.

Knowledge of COVID-19, use of personal protective equipment and other safety practices of healthcare workers in southwest Nigeria

Background:Healthcare workers have a higher risk of SARS CoV2 infection with implications for transmission of infection and the safety of workers and patients. Objective: To assess knowledge on COVID-19 and the safety practices among selected healthcare workers in southwest Nigeria. Methods:A cross-sectional study of 210 workers providing direct care to patients during the COVID-19 pandemic was conducted. Respondents wererecruited through simple random sampling of members of online platforms of healthcare workers in Osun, Ondo and Ekiti States. Information on sociodemographic characteristics, knowledge of PPE and safety practices was obtained through a close-ended questionnaire. Results: The mean age of the respondents was 36.5±7.5 years. About 29% and 30% of respondents were from the State and Federal Government-owned Teaching Hospitals, respectively. A little above half (58.1%) had good knowledge of COVID-19, while 62.1%used PPE always when attending to suspected COVID19 cases. More than half (53.8%) had been trained on infection prevention and control (IPC), but only 34.3% adhered to good safety practices. Healthcare workers in State government-owned teaching hospitals had lower odds of good safety practices than those in Federal Teaching Hospitals (OR = 0.42, 95% CI = 0.19-0.93, p = 0.031).Conclusion: The knowledge of appropriate PPE and practice of safety precautions among healthcare workers is sub-optimal. This may predispose to increased COVID-19 transmission among healthcare workers, patients, and their families. Training and retraining healthcare workers, especially those from hospitals identified by the study as having poor safety practices, should be encouraged.

First Episode Psychosis during COVID-19 Pandemic: A Case Series.

INTRODUCTION: Neuropsychiatric events are often associated with viral pandemics. The unexpected turn of events the world over since the onset of the coronavirus pandemic may serve as stressors which can trigger or worsen mental disorders particularly psychosis. There is little or no reports about acute psychosis on the background of this current global pandemic particularly in the African context. The aim of this article describes a case series of acute schizophrenia-like disorder with COVID-19 related psychotic themes in the context of the current pandemic. MATERIALS AND METHODS: We present a case series of 2 patients with first episode psychotic illnesses during the COVID-19 pandemic. Both patients presented at the mental health outpatient clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: Two patients with no previous history of mental illness presented with COVID-19 delusional themes and odd behaviours. Mental state examination revealed abnormalities in behaviour, thought system, perception and cognition. ICD10 diagnosis of Acute and Transient Psychotic disorder was made in both patients. There were no abnormal physical health findings and symptoms resolved with the use of antipsychotics. CONCLUSION: Information on the COVID-19 pandemic may influence the content of psychotic experiences among the general population. A high index of suspicion and acute services are important to ensure prompt intervention and promotion of community mental health. Clinicians need to be well informed to be able to identify what deviates from the norm, and to be able to provide prompt intervention.

INTRODUCTION: Les événements neuropsychiatriques sont souvent associés aux pandémies virales. La tournure inattendue des événements dans le monde depuis le début de la pandémie de coronavirus peut servir de facteurs de stress pouvant déclencher ou aggraver des troubles mentaux, en particulier la psychose. Il y a peu ou pas de rapports sur la psychose aiguë sur le fond de cette pandémie mondiale actuelle en particulier dans le contexte africain. Le but de cet article décrit une série de cas de troubles de type schizophrénique aigu avec des thèmes psychotiques liés au COVID-19 dans le contexte de la pandémie actuelle. MATÉRIELS ET MÉTHODES: Nous présentons une série de cas de 2 patients présentant un premier épisode de maladie psychotique pendant la pandémie de COVID-19. Les deux patients se sont présentés à la clinique externe de santé mentale du complexe hospitalier universitaire Obafemi Awolowo, à Ile-Ife, au Nigéria. RÉSULTATS: Deux patients sans antécédents de maladie mentale ont présenté des thèmes délirants et des comportements étranges liés à la COVID-19. L'examen de l'état mental a révélé des anomalies dans le comportement, le système de pensée, la perception et la cognition. Le diagnostic ICD10 de trouble psychotique aigu et transitoire a été posé chez les deux patients. Il n'y a eu aucun signe anormal de santé physique et aucun symptôme n'a été résolu avec l'utilisation d'antipsychotiques. CONCLUSION: Les informations sur la pandémie de COVID-19 peuvent influencer le contenu des expériences psychotiques au sein de la population générale. Un indice élevé de suspicion et des services aigus sont importants pour assurer une intervention rapide et la promotion de la santé mentale communautaire. Les cliniciens doivent être bien informés pour pouvoir identifier ce qui s'écarte de la norme et pouvoir intervenir rapidement. MOTS-CLÉS: COVID-19, psychose aiguë et transitoire, pandémie, premier épisode de psychose, facteurs de stress.

Sleep quality and cognitive impairments in remitted patients with schizophrenia in Nigeria.

BACKGROUND: Despite the ubiquity of sleep disturbance in schizophrenia, it has generally been overlooked as a potential contributor to cognitive impairments. The main aim of this study was to find out if impaired sleep quality contributes to cognitive impairments in patients with a diagnosis of schizophrenia who are in remission. METHODS: The study was conducted at the University College Hospital, Ibadan and State Hospital, Ibadan, Nigeria. The Pittsburgh Sleep Quality Index (PSQI) and Screen for Cognitive Impairment in Psychiatry (SCIP) were applied in this cross-sectional study, to all consecutive and consenting remitted outpatients with schizophrenia (N=130). Other instruments such as Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), sociodemographic and clinical measures were also applied. RESULTS: There were 130 participants made up of 69 females (53.1%) and 61males(46.9%). The mean age of the participants was 38.5±9.1 years. The prevalence of poor sleep quality in remitted patients with schizophrenia was 56.9%. Sleep quality was significantly negatively correlated with Verbal Learning Test-Immediate (VLT-I) (r(128)=-.18, P=.044) and Verbal Learning Test-Delayed (VLT-D) (r(128)=-.18, P=.037). The variables that independently predicted cognitive functioning were the VLT-I, odds ratio (OR) 0.66; 95% confidence interval ((CI) 0.49-0.88) and education (OR) 0.61;(CI) 0.40- 0.92). CONCLUSION: Poor subjective sleep quality measured by the PSQI is linked to cognitive impairment in remitted patients with schizophrenia. We suggest that sleep quality in remitted patients with a diagnosis of schizophrenia should receive better attention by physicians.

A Study of 31 Patients with Primary Complaint of Halitosis in a Tertiary Hospital in South-Western Nigeria.

BACKGROUND: Halitosis is a common cause of dental consulta-tion. Patients presenting with primary complaint of halitosis consist of dissatisfied people with genuine and pseudo-halitosis. OBJECTIVES: To assess the demographic and clinico-pathologic features of patients presenting with primary complaint of halitosis as well as evaluate the treatment outcome. METHODS: Consenting patients presenting with primary complaint of halitosis from 1st of March to 31st August, 2015 were recruited. All had intraoral examination, were screened for psychiatric morbidity and halitosis using the organoleptic method. Data concerning the complaint of halitosis was retrieved from all through an interviewer-administered structured questionnaire. All the patients were educated on the aetiology of halitosis, those with oral disease were treated and all had scaling and polishing, oral hygiene instruction/motivation in addition to hydrogen peroxide mouth rinse for two weeks. Patients' opinions were sought concerning the presence/intensity of halitosis at two weeks and six months post treatment. RESULTS: Thirty-one patients with a mean age of 38.48 years and male:female ratio of 1.3 were recruited. Intraoral pathology was observed in 48.4% of patients. None of the patients smoked cigarette or pipe. Twenty patients (64.5%) had been informed of the foulness of their breath by at least one person in the past; the information generated negative feelings in 19 of them. Six patients had psychiatric morbidity which was significantly associated with female gender and presence of body odour. At two weeks post treatment, 54.8% of patients were free of halitosis, while at six months only 25.8% were free. CONCLUSION: The patients who complained of halitosis were non-smokers with a mean age of 38.48±14.0 years. Intraoral pathologies were found in fifteen (15) patients, while six (6) had psychiatry morbidity. About half of the patients and about a quarter were free of halitosis following scaling and polishing and two weeks' hydrogen peroxide mouth rinse at 2 weeks and 6 months' reviews, respectively.

Partnership for mental health development in Sub-Saharan Africa (PaM-D): a collaborative initiative for research and capacity building.

AimsIn low- and middle-income countries (LMIC) in general and sub-Sahara African (SSA) countries in particular, there is both a large treatment gap for mental disorders and a relative paucity of empirical evidence about how to fill this gap. This is more so for severe mental disorders, such as psychosis, which impose an additional vulnerability for human rights abuse on its sufferers. A major factor for the lack of evidence is the few numbers of active mental health (MH) researchers on the continent and the distance between the little evidence generated and the policy-making process. METHODS: The Partnership for Mental Health Development in Africa (PaM-D) aimed to bring together diverse MH stakeholders in SSA, working collaboratively with colleagues from the global north, to create an infrastructure to develop MH research capacity in SSA, advance global MH science by conducting innovative public health-relevant MH research in the region and work to link research to policy development. Participating SSA countries were Ghana, Kenya, Liberia, Nigeria and South Africa. The research component of PaM-D focused on the development and assessment of a collaborative shared care (CSC) program between traditional and faith healers (T&FHs) and biomedical providers for the treatment of psychotic disorders, as a way of improving the outcome of persons suffering from these conditions. The capacity building component aimed to develop research capacity and appreciation of the value of research in a broad range of stakeholders through bespoke workshops and fellowships targeting specific skill-sets as well as mentoring for early career researchers. RESULTS: In the research component of PaM-D, a series of formative studies were implemented to inform the development of an intervention package consisting of the essential features of a CSC for psychosis implemented by primary care providers and T&FHs. A cluster randomised controlled trial was next designed to test the effectiveness of this package on the outcome of psychosis. In the capacity-building component, 35 early and mid-career researchers participated in the training workshops and several established mentor-mentee relationships with senior PaM-D members. At the end of the funding period, 60 papers have been published and 21 successful grant applications made. CONCLUSION: The success of PaM-D in energising young researchers and implementing a cutting-edge research program attests to the importance of partnership among researchers in the global south working with those from the north in developing MH research and service in LMIC.

Assessment of normal forearm compartment pressures in a Nigerian population.

PURPOSE: The forearm is prone to raised compartment pressure and it is the second most common site for compartment syndrome. The normal compartment pressure of the forearm should be known and serve as a benchmark for the diagnosis of acute and chronic compartment syndrome. This study was aimed to determine the normal compartment pressures of the forearm using a digital compartment pressure monitor. METHODS: This was a prospective hospital-based study of the uninjured forearm in 30 patients, who presented with closed unilateral forearm fracture at the accident and emergency department of a tertiary health care facility, between June 2012 and December 2013. Approval was sought and obtained from institutions ethical committee. An 18 gauge bevelled-tip needle, attached to a Compass TM digital compartment pressure monitor made by Mirador USA, was used to measure the pressures in the compartments of the forearm. Data obtained were analysed using the Stata 12. Significance was determined at p < 0.05. RESULTS: The mean age was 38.3 ± 18.3 years with male-to-female ratio of 2.3:1. The pressures in the volar compartment of the forearm ranged from 1 to 8 mmHg with a mean ± SD compartment pressure of 4.7 ± 1.5 mmHg. In the dorsal compartment the pressure ranged from 2 to 8 mmHg with a mean ± SD of 4.9 ± 1.7 mmHg SD, while the lateral compartment measurement ranged between 1 and 5 mmHg with a mean ± SD of 3.6 ± 1.1 mmHg. There was significant positive correlation (p < 0.01) between the compartment pressures in the volar, dorsal, and lateral compartments. CONCLUSION: The normal compartment pressure for forearm is 4.4 ± 1.6 mmHg and ranged from 1 to 8 mmHg from this study in our environment. This will serve as reference value when forearm compartment pressure is being measured.

The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries.

BACKGROUND: Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations. METHOD: We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models. RESULTS: Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9-2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6-20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF). CONCLUSIONS: Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.

Quadriceps strength and anterior knee pain following tibia intramedullary nailing: Any clinical relationship?

INTRODUCTION: Anterior knee pain can be chronic sequelae of intramedullary nailing of the tibia. Several causes have been identified; no single reason can fully explain the occurrence. We, therefore, set out to find the rate of anterior knee pain in our practice and if any relationship exists between the anterior knee pain and extensor muscle strength. METHODOLOGY: A total of 72 knees in 36 patients with no prior history of knee pain, but had unilateral tibiofibular fracture, who had internal fixation with interlocking intramedullary nailing done and were followed up for at least 1 year were recruited into the study. The tension generated on extension of the knee against a resistance using tensiometer was measured in Newton. The ranges of motion of the knees were documented, as well as Lysholm score which measures activities and document the presence and limitation caused by anterior knee pain. RESULTS: A total of 36 patients with 72 knees were studied. Anterior knee pain occurred in 7 (19.4%) patients in this study. There was no statistically significant relationship between the force of tension (N) generated in the extensor in patients with anterior knee pain compared with those without knee pain (158.43 ± 49.35, 189.54 ± 74.63, P = 0.304). There was, however, a significant statistical relationship between the mean Lysholm score of the operated and unoperated knee (P = 0.042). CONCLUSION: Anterior knee pain rate was 19.4% in our series and no statistical association exists between the extensor strength and occurrence of anterior knee pain.

The incidence of psychoses in diverse settings, INTREPID (2): a feasibility study in India, Nigeria, and Trinidad.

BACKGROUND: There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites. METHOD: In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants. RESULTS: Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan. CONCLUSION: Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.

A Novel Method to Assess Bone Marrow Purity is Useful in Determining Blast Percentage by Flow Cytometry in Acute Myeloid Leukemia and Myelodysplasia.

Blast quantification by Flow Cytometry (FCM) may become essential in situations where morphologic evaluation is difficult or unavailable. As hemodilution invariably occurs, a means of determining Bone Marrow Purity (BMP) and normalizing FCM blast counts is essential, especially when blast percentages are diagnostically critical as in Acute Myeloid Leukemia (AML) and Myelodysplasia (MDS). By evaluating different leukocyte populations in eight initial patients, a formula to predict BMP was developed and compared to the actual BMP determined by manual counts. Performance of the formula was then validated in 86 AML/MDS patients by comparing normalized FCM blast counts to those determined by the reference manual method. A BMP formula was empirically developed, primarily based on changes in lymphocytes which reliably correlated with the actual BMP (R2 = 0.8955). Components of the formula were derived entirely from automated lymphocyte and total leukocyte counts from the peripheral blood and FCM analyses. BMP formula was then validated in 86 AML/MDS patients. When used to normalize blast counts, the formula showed accurate correction when BMP fell between 40%-90%. In this group, correlation of normalized FCM and manual blast counts was acceptable (R2 = 0.8335), being greatest at lower blast percentages. Normalization of the FCM blast count appropriately reclassified disease in 26.8% of cases. We identified a practical means of estimating hemodilution and allowing FCM blast normalization in the evaluation of AML and MDS. BMP assessment by this simple method improves the quality of the FCM data and facilitates accurate diagnosis and patient management.

Antegrade Versus Retrograde Approach to Interlocking Nail Fixation of Femoral Diaphyseal Fractures: Is there Difference in Time to Union?

BACKGROUND: Antegrade reamed interlocked intramedullary nailing is the treatment of choice forfemoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nail. METHODS: This was a prospective comparative study. Consecutive patients were placed alternately into a study group (retrograde nailing) and a control group (antegrade nailing) in a ratio of 2:1 i.e two retrograde nailing for every antegrade nailing. Forty one fractures had interlocking intramedullary fixation via the retrograde approach (study group), while the control group consisted of twenty fractures that had fixation via the antegrade approach. All were followed up for a minimum period of nine months (range of nine to twenty-four months). RESULTS: The mean duration of surgery in the retrograde group was 157.07minutes and 137.40 minutes in the antegrade group (p=0.093). The mean duration to fracture union was 16.98±4.71 weeks in the retrograde group and 15.80±5.43 weeks in the antegrade group (p = 0.388). There was no incidence of non-union in the two groups. CONCLUSION: Retrograde approach compares favourably with antegrade approach for intramedullary interlocking nail fixation of diaphyseal femoral fracture in adults with respect to time of fracture healing.

Influence of organic carbon and metal oxide phases on sorption of 2,4,6-trichlorobenzoic acid under oxic and anoxic conditions.

Chlorobenzoic acids represent crucial recalcitrant metabolites in the environment; thus, the influence of soil components on the sorption of 2,4,6-trichlorobenzoic acid (TCB) under oxic and anoxic conditions was studied. The surficial physiognomies of untreated and isolated soil samples were studied using FTIR, XRD, specific surface area, and PZC determination. The roles of redox potential, dissolved organic carbon (DOC), and pH, particularly under anoxic condition, were appraised. Batch equilibrium adsorption studies on soils of variable Fe/Mn oxides and organic carbon showed that adsorption was low across all components (log Koc = 0.82-3.10 Lg(-1)). The sorption of 2,4,6-TCB was well described by the pseudo second-order kinetic model. The fluctuation of both redox potential and pH during anoxic experiment had a negative impact on the sorption, partitioning, and the oxidation of organic matter. Linear relationships were observed for Kd with both soil total organic carbon (TOC) and surface area (SA). The results showed the existence of DOC-mediated sorption of 2,4,6-TCB which seems to be enhanced at lower pH. The reductive dissolution, particularly of iron compounds, possibly impeded sorption of 2,4,6-TCB under anoxic condition. It could be inferred that habitats dominated by fluctuating oxygen concentrations are best suited for the development of environmental conditions capable of mineralizing 2,4,6-TCB and similar xenobiotics.

Implant failure in lower limb long bone diaphyseal fractures at a tertiary hospital in Ile- Ife. Nigeria.

AIMS AND OBJECTIVES: This included determining aetiology of failure and comparing the failure rate in implant fixations using solid intramedullary nail and DCP. PATIENTS AND METHODS: A retrospective study conducted at the Orthopaedic Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife,Nigeria. Records of all operated cases of lower limb long bone diaphyseal fractures including those with failed fixations from August 2006-July 2011 were reviewed. Data retrieved included type of implant used, aetiology and characteristics of Implant failure. Data were analysed using SPSS version 16. Frequency distribution of the variables of interest was done. Difference in failure rate of intramedullary nail versus DCP was tested using chi-square. Statistical significance was inferred at p<0.05. RESULTS: A total of 280 patients were studied out of which two hundred and twenty-one patients had long bone diaphyseal fractures and met inclusion criteria, of which 135 had intramedullary nail fixation and 86 had DCP. The rate of implant failure in intramedullary nail was 1.5% while it was 5.8% in patients with DCP (p=0.113; 0R=4.10; 95% CI=0.65- 43.77). Implant fracture was the commonest type of failure seen (100% versus 60%) and non union was the commonest cause of failure seen (50% versus 40%) in the intramedullary nailing and DCP groups respectively. CONCLUSION: The likelihood of a failed implant is higher in fixations done with DCP compared with intramedullary nail though the difference was not statistically significant. Commonest reason for failure in both groups was non-union. Findings from this study may guide surgeons in choice of implant in the management of long bone fractures.

Comparison of unreamed interlocking nail and external fixation in open tibia shaft fracture management.

BACKGROUND: The management of open tibia fractures remains controversial despite increase in its incidence. Some surgeons avoid internal fixations for fear of infection while others have demonstrated its superiority. Identifying an optimal management modality is of utmost benefit to our patients. Study objectives were to compare the rate of infection and mean duration to healing in the management of open tibia fractures using unreamed interlocking intramedullary nail and external fixation. METHODS: The study was an interventional study comparing two known standard methods of managing open tibia fractures conducted in the orthopaedic and trauma department of a tertiary health institution in South west, Nigeria. Forty patients who presented with open tibia fractures were allocated alternately into primary interlocking nailing group and external fixation group. Follow-up was for two years. RESULTS: Incidences of deep wound infection in both groups were 35% (external fixation) and 11.1% (interlocking nailing) respectively. The relative risk of developing infection in external fixation group was 3.2. Mean duration to union was 14.8 weeks and 14.4 weeks in the external fixation and interlocking nailing groups respectively, difference in mean was not statistically significant, (t=0.133, p=0.895). CONCLUSION: The risk of wound infection was observed to be higher in this study with the use of external fixation in the management of open tibia fractures compared with unreamed interlocking intramedullary nail.

Comparison of effect of retrograde and antegrade approaches to interlocking nail fixation of femoral diaphyseal fractures on ipsilateral hip and knee joint motion.

PURPOSE: The objective of this study was to evaluate the early impact of antegrade and retrograde interlocking nail fixation of femoral diaphyseal fractures on the ipsilateral hip and knee joint range of motion. METHODS: A prospective evaluation was performed of 62 consecutive limbs with femoral diaphyseal fractures that had interlocking nail fixation through the antegrade or retrograde approaches. All participants had post-operative physiotherapy. Follow-up was for 9 months. RESULTS: The mean maximum hip flexion angle at 9 months was 137.50 in the antegrade group and 133.80 in the retrograde group (p = 0.150). Trendelenburg test was negative in both groups and there was no knee extension lag at 9 months. While the mean maximum knee flexion angle at 9 months was 119.90 in the retrograde group and 134.50 in the antegrade group (p = 0.023). All patients had achieved radiologic and clinical fracture union by twenty four weeks post-operatively. CONCLUSION: There was no significant effect of antegrade or retrograde approach on the range of motion of the hip joint. However, knee motion improved more quickly in the group that had antegrade nailing.

Breastfeeding practices of physician-mothers in Ife and Ilesa zones, Osun State, Nigeria.

BACKGROUND: Physician-mothers' breastfeeding behaviour is being studied because it is believed to impact their anticipatory guidance to their patients, which in turn influences patients' breastfeeding initiation and continuation. Study assessed the breastfeeding practices of physician-mothers; their reasons for stopping exclusive breastfeeding and factors associated with their breastfeeding practices. METHODS: Study design was cross-sectional, conducted in Osun East Senatorial District, Nigeria. A self-administered semi-structured questionnaire was administered to all eligible 56 physician-mothers in public primary, secondary and tertiary health facilities in the reproductive age-group whose youngest child was aged d"five years. Informed consent was obtained. Outcome measures were time breastfeeding was initiated, duration of exclusive breastfeeding; reasons for stopping exclusive breastfeeding and duration of continued breastfeeding. Data was analysed using SPSS version 17, statistical significance was determined at p-value < 0.05. RESULTS: Fifty (89.3%) responded. Seventy per cent initiated breastfeeding within 1 hour after birth; exclusive breastfeeding rate was 28.0% with a mean duration of 4.1 +/- 1.9 months. Mean duration of continued breastfeeding was 14.5 +/- 4.5 months. Commonest reason for stopping exclusive breastfeeding was 'baby old enough' (35.8%). Mode of delivery was statistically significantly associated with time to initiate breastfeeding. Time to initiate breastfeeding was statistically significantly associated with duration of exclusive breastfeeding. CONCLUSION: Breastfeeding practices of physician-mothers do not conform to the standards in the Innocenti Declaration. The impact of this on their professional support to clients' should be measured in further studies. It is recommended that targeted interventions be done to improve the attitude and breastfeeding practices of physician-mothers.

Influenza A(H1N1)pdm09 and flu response centres: characteristics of flu response centre staff in the West Midlands.

OBJECTIVE: To assess the operational experience and knowledge of staff who worked in the West Midlands Flu Response Centre (FRC) during the 'containment' phase of influenza A(H1N1)pdm09. STUDY DESIGN: Evaluation study. METHODS: Cross-sectional survey of staff who worked in the West Midlands FRC between 18 May 2009 and 10 July 2009 using an online self-administered questionnaire. The questionnaire included sections related to the respondents' FRC experience, knowledge about influenza A(H1N1)pdm09 and the containment phase. RESULTS: This study had a 51% (89/176) response rate. Of the respondents, 59% were female, 64% were of White ethnicity, 55% were clinicians, 46% were aged 25-44 years, and 67% had no previous call centre experience. A significant proportion (P < 0.001) of respondents believed that the FRC had made a positive contribution to the public health management of the containment phase. Nearly all respondents indicated that they were familiar with the terms 'pandemic flu' or 'influenza pandemic' (99%), understood the aim of the containment phase (90%), and knew the severity of the illness caused by the virus (97%). However, specific knowledge was lacking regarding a number of public health interventions, and overall knowledge scores for clinicians and non-clinicians were similar. CONCLUSION: This study is the first to report on the characteristics of FRC staff during the containment phase of influenza A(H1N1)pdm09 pandemic. Although overall, staff evaluation of the West Midlands FRC was very positive, a number of knowledge gaps were identified. This study provides valuable insights which can contribute to preparedness planning.